Vasodilator therapy in acute myocardial infarction.

In the context of these studies, the evidence indicates that cardiac performance can improve significantly during vasodilator therapy in acute MI complicated by pump failure. Although the clinical course in uncomplicated patients is good, even without active therapeutic interventions, prognosis in patients with pump failure treated by standard methods (digitalis and diutetics) is discouraging. Hospital mortality approaches "40 per cent in patients with moderately depressed cardiac function and may reach as high as 100 per cent in patients with severe pump failure and/or cardiogenic shock." The evidence presented suggests that early and cautious vasodilator therapy may significantly alter this poor prognosis by its beneficial effects on both LV function and the determinants of myocardial oxygen consumption.